Provider Demographics
NPI:1336438910
Name:PETRASHEUSKAYA, MARYNA (DDS)
Entity Type:Individual
Prefix:
First Name:MARYNA
Middle Name:
Last Name:PETRASHEUSKAYA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 STATE ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-1914
Mailing Address - Country:US
Mailing Address - Phone:814-454-4530
Mailing Address - Fax:814-456-2375
Practice Address - Street 1:1611 STATE STREET
Practice Address - Street 2:465
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501
Practice Address - Country:US
Practice Address - Phone:814-456-8548
Practice Address - Fax:814-455-9015
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039227122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program